Background Checks for Healthcare Workers

Healthcare industry workers routinely deal with some of the most emotionally and physically taxing work in the professional world. In many situations, patients are uniquely vulnerable (either mentally or physically, and sometimes both). Understandably, then, we must pay special attention to the professional and emotional integrity of our healthcare professionals in order to maximize patient safety. What sorts of screening procedures are involved if a person wishes to work in a hospital or nursing home facility? Is there evidence that these screening procedures (background checks included) are effective?

The Omnibus Budget Reconciliation Act (OBRA) of 1987 first brought national attention to the problems facing long-term care (LTC) patients. Prior to this legislation, the widespread problems of verbal abuse, theft, and physical abuse were relatively undocumented. In response, the Omnibus Budget Reconciliation Act established the legislative framework that would eventually mandate background checks for all workers in long-term care facilities, as well as a nationwide agency to oversee how individual states implemented these directives. The programs themselves were enacted by the Affordable Care Act (also known as Obamacare or the ACA).

While the Affordable Care Act is better known for mandating that all small business owners with 50 or more full-time employees must provide health insurance benefits for their full-time staff, the ACA also directly addresses routine background checks for long-term care facility workers and nursing home staff. Jurisdiction for these programs is currently managed by the Center for Medicare and Medicaid Services (CMS), as well as the Federal Bureau of Investigation (FBI) and the Department of Justice (DOJ). The Center for Medicare and Medicaid Services has directly participated in funding background checks by providing more than $50 million to 24 states for employees who have direct patient access. The National Background Check Program is now routinely reevaluated for effectiveness by the Health and Human Services Office of Inspector General (HHS OIG).

Even with these precautions, violations still occur. Healthcare workers, particularly ones who work in long-term care facilities, may face frequent physical and verbal abuse from patients with conditions (e.g., Alzheimer’s disease) that degrade mental faculties. Workers hired without criminal background checks and/or sufficient training may succumb to impatience and retaliation. Psychological screening and training courses will help reduce the incidence of these events, but families considering a nursing home for their loved ones are advised to ask both staff and residents directly regarding any recent incidences of abuse. Staff that violate local policies will likely face disciplinary action, but families should also inquire as to prevalence of volatile patients who may produce staff tension.